Permit CITY OF TIGARD BUILDING PERMIT
111 : COMMUNITY DEVELOPMENT Permit#: BUP2021-00285
Date Issued: 2/10/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD12300
Jurisdiction: Tigard
Site address: 10873 SW ANNAND HILL CT
Project: Annand Hill,Lot 2,(2 of 2)ADUs Subdivision: ANNAND HILL CT PARTITION Lot: 2
Project Description: New multi-family dwelling on the upper level.Trade permits to be obtained separately. NO FINAL INSP UNTIL
WATER METER UPSIZED.
Contractor: BLUE PALOUSE PROPERTIES Owner: BLUE PALOUSE PROPERTIES LLC
333 S STATE ST, SUITE V452 333 S STATE ST STE V452
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034
PHONE: 503-936-3212 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: MF
Class of Work: NEW Type of Const: VB Building Permit-New Construction 02/09/2022 $915.06
Occupancy Grp: R-2 Occupancy Load: 4 Plan Review 11/25/2021 $751.34
12%State Surcharge-Building 02/09/2022 $109.81
Dwelling Units: 1
Wash Co Trans Dev Tax- 02/09/2022 $5,756.00
Stories: 1 Height: 0 ft Condominium/Townhouse
Bedrooms: 2 Bathrooms: 2 Plan Review-Fire Life Safety 02/09/2022 $366.02
Value: $111,689 Metro CET 02/09/2022 $134.03
DC Provision Review,SF-Ping 02/09/2022 $110.00
Plan Review 02/09/2022 $-5.80
Floor Areas: Tig-Tual School CET-Residential 02/09/2022 $1,300.02
Total Area: 922 Plan Review 02/09/2022 $-150.75
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 24
Garage: 0
Mezzanine: 0
Total $9,285.73
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Yes Parapet: No
Fire Alarm: No Protected Corridors: No
Smoke Detectors: Yes Manual Pull Stations: No
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503,232.1987 or 1.800.332.2344
Issued By: Eolga.rdv-Ma-(.do odo-- Permittee Signature: y.,e,
Call 503.639.4175 by 7:00 a.m,for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
'
ii
Build:int Permit Application
. i ( RECEIVED � �E t tlZ t)l L S ;''.I
City of Tigard Received !0/4 0/Zoo' r Permi No._ 1- i
g Datdliy: iria- _. _ V001 1'
4* 11124 SW Hall Blvd.,Tigard,OR 97223 pCT 21 2021 Plan Review �j/�fp�n
Phone: ,503.718 2439 Fax: 503.598.1960 Date/By: Other Peru iii4 M// -�Z75 .
�; ;'}; Inspection Line: 503.639.4175 Date Read B E) eL PA T for ;l
p CITY OF TIGAR!� Y Y
Internet: www.tigard-or.gov
i 'up*mettaltutornuuzcn I`
BUILDING DIVISION ------ —
4f i` t'i r c� $ t rf�`--;iiFci, a i p r ,e'. i l,�Hac.ai-al r x r "'14.... ,. .,s a f .:,�1 33 'tl/ ili.. :,` i,
�^ y $"}jf y��r ry �t j ryt'
igli t,LI, 47"..T: .k'.1 oe, ..A-�..� ..;''1 `t � r i I"''�C Y B if Ri >, F1 I f 4N• !l '��Yl .:t.'
Y.,-Ha:, aat 1 l.t= is„t,E,,:;;.,Ll .,.�,«,a-�..` � r,r .t„
! New construction ❑Demolition -_ Pv mi:fees*are based on di;value al the a,-rlt perfonned.
indicate the value(rounded lc ttc n"ar:sl c.)ll:a•l of all 1
❑Addition/alteration/replacement 0 Other: c riainent,materials,labor.ov •he-td,and , profit for the
1 fr; t t ca _c ri /+ •t< di > II t c:t.
•
M. : n:
tir I-and 2-family dwelling 0 Commercial/industrial
Ntnnber of bedrooms: \ -
❑Accessory building ❑Multi-family -_ ___ �/ �
❑Master builder r ❑Other: Number of bathrooms: Z- - - -
!.r rx l a air t it A„ ¢ ,°a., d e ;ro .,,' ki io „ 8� i-*�t°.� ,� s ._; Total numoer Of floors: i
Job site address: (D r,3 5w A uithetN/-) ma GT _ — — — _New dwelling area: 1'2 square red
-
City;State!Z[P: y, � Gl' ZZ� - - - Garage/carport al;e,ca,port area: square -et ____
Suite/bldg'apt.no.: "► Project nargiipr#' !/r/� � _ Ca"�ered porch area: square cei
Cross street'directions to job site: � dth. '�f Devi(area: fr-- --square reel I
Otter siruct.tre area:# �y square
e#lee:l A
Subdivision: Lot co.: j- Pcueai,fees*are based on the value J1 :he wcrk perfonned. l'
— -- ----- Indicate the value(rounded to atc nt aresl dollar)of all
Tax map/parcel no equipment,materials,labor,overhea d,and the profit for the
t tw zACii a g _, `� r a t,fr ( I'r work ndicatdd ontki as ticaaiart. ___________ f•
A"D0-1 . . UPPER- --VE ) - _- Valuation: $ - - --- - -- -- 4
�[ 1.
1�� � ���� SY _ !`�—_ — 6'ascng building area: ----square reel -- ''
/i' !fit - New building area: -�� --square eet
...sa K 6 r- �s 97. Y ` �,'.,`{:.. .ix�. ,,..:... l3tr�• s...
;Ir�F4.'I:.� ' , '1 , a`.'ral' t` .( r 5"'r N'Jmberof[tortes:
". ,, 3c...-....W...�. d.>... , ,gym .. :�J'°L`Ertx.P _ ------------------------ ,i
Name: f �lA2 aar _ , popi TT�T -_ - T:,peofconstruction: ,
Address:533 $ C7}-, -- sT SC"/ .� -------- Occupancy groups:
City/State/ZIP: l 1-It " t=sl �� -- - --- - Existing:
Phone:( � f,93[� 3z f Z Fax t ) New:
-
,k .tat u-)r s^"'"I3 z C 1Y.4 k`sdtLC ta,:�5' .' '-s. ,y 7s ar e i g s of a r
"rI�ki, F;Wl; liPj*< ,< , c t r:I c�., t*lt! -F"; 414H�a l :it i�r1:Qr"tdl'Jr,ri'ft t� i
Business name: ,l � n _ su ..':.,a iat ;i;. N b.t. ...
-- — --------- Strucn:al plan review fee(,adi.'po it)
Contact nanie: -- - -- - --- - - - .- -- ----- FI S plan review fee(if sppl'cab 1',e): 1
Address: ----- ----- -- - - - -
- - - Total fees due upon appl'cab on
City/State/ZIP: - ------- ------------..
Phone:( ) Fax: :( )-- -- -- - Amount re eis ed
E-mail: a It, ta,,a t ,,. , .di :� ... [1
2 a g til+s r a r zifilComm Comercial and residential )rescrir tiv installation of
iv r rag
.1;1c x..a_,,,.z,:i ._ ., t< L :d+,:.. L ...1 d:'.; t a iii t”i a root-top mounted Photo Voltaic )Jiltr Farrel Sr tern. ";
Business name: &VC
Sub two('?)sets of roof plan wit t conaxtion details
P � $E P2Oft 77�
m— and fire depalnent access,along w th the 2010 Oregon
33 3
Address: � Sm7 ST. s j I T f4.c2 .Solar- Installarion Specialty checklist. _
-' Permit Fee(includes plan rev ess
City/State/Z,IP: G te OS — ---— $18C".00
-_-- --- and adn inistrative fees):
Phone:( )19 ax:I ) q,
. Pho-_ 36 7 1_F --._ Sure surcharge(12 0 ofpenult fi:e): g21.60
�CCB tic.: /� —7
___��7(/�/ --_----__--- Total fee due upon app cat.on 121;1.60
Authorized i ignature: This permit application expire,if a permit is not ddat;aimed
within 18(1 days after at has barn accepted as complete,
Print name: -_-- -/(� 5. Date: - - ---- Fee methodology set byTti-County3uitdingindustry
( ►`e L f (� �0 5etviee Board.
I:\Building\Permits`BUP-RESPermitApp.doc 02/24/2011 440.46I3T(11i02/COM/WEB l
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Mechanical Permit Applicatigt`f� , ������II���I"� >�tl i tt 1 l st t��tN I{;
City of Tigard (RECEIVE At Received permit No: /i /9x I';
N..- . 13125 SW Hall Blvd.,Tigard,OR 97223 rr,, q Date/By: y ' �� ?
Phone: 503.718.2439 Fat.: 503.598.1960 U C I i �� I plan Review
Date/t3y: Other Permit:
1 a
ti;1 R I
Inspection Line: 503.639.4.175 y — --� iuri: fi!See Page z for
te Read/By:
inInternetwww.tigard-or.gov CITY OF 1 IGARD N Dao1.!ReaKetlwd: 6u ementallnformation
BUILDING DIVISIO
PPt
1t s t r n5 atr b� :ir Etta x , i i d{ •� 1"" a aTi € i.i. m „,� ,
t .r. i s ,, i 4' , .: „12!i I. )1 ,.1„ � I (E, 1g t1 al ¢it 1 s�"ri'
Mechan:cul permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement perfcnm:d.Indicate the value(rounced to the nearest dollar)of all
mechani equipment,la,)or,ov:rhea and rofit.cal materials,a u s j
❑Demolition 0 Other: —_— 4'
malu., $
i taEl � t 1 illiireirAirflak,144
¢ a a r r ' ° i
,.Il
❑ ?-and 2-family dwelling 0 Commercial/industrial ❑Accessary building For special information ass checklist.
❑Multi-family 0 Master builder 0 Other Descript.on Qty.. Ea. Total
if f ili iFi y a fig 1 a l a r a i, lteatin 'utu1-th" _
Jobsiteaddress: ! 0D /3 50 A-A/A4 D R{ �/ -Fur Furnace
conditioning 46.75
RUG. Furtratce 100,000 BTU(ducct!ven:s) 4ti.75
City/State/ZIP: 71 /7 O/t Fumace 100,00(H BTU(ductsrvens) __—54,91
— -- a nu 1 6__t)6
Suite/bldg.apt.no.: Project name: Ile ——
— •---- — ------- I)actwok __ L 23."2
Cross streetidirections tojob site: }y ;,)��t G����y�a�����,�,�(/�_�%� Fltidr�ni,:hot water system
Rcs del ial butler(radiator or
Unit hca:crs(fuel-type.not electric).
in-wall,in-duct,suspended,etc. 46,75
Flue/vent for any of above 23.32
Subdivision: ; Lot no.: Other: 23.:2
Z
Other fuel appliances:
Tax map/parcel no.: 5 //Q Ao /2-3GO _ _Water neater / 23.32
$1r .,,,t;..ills t �� x""sea "_,..}_�.,j.iigi sr & "s" xr<.., r ,. £ gtb ,1 (.. !. F 1L 1 }a' 1 ntfa3( Cras Sire>lace/insert 33.39
a i1 Flue vest c for water heater or gas
fireplace 17 23.32
Leg lighter(gas) 23.32
1:
— Wood/pellet stove -- 33.39
— ___ —` Wood,`ii eplacelinsert 23.32 II"
CFwl:ne;/liner/flue/vent 23.32 I'•
�* FR `I Other: 23.32 11
_°_ _'a .s a ' s ,.: `5 is-' ,, aujm. •'g:'•
r al`a• :° ,'8 a it lg s O Oval Environmental exhaust and ventilatio t:
Name: ,FL,tie- /W.Otrs� C �QeZ 85 Range hood/other kitchen I
1
_ / e�cuipmeat , 33.39 _ 1
Address: 3,3 ,j SM7" 57 5(1// V , z_ Clothes dryer exhaust 3.3.397— — f
City State%LIP_ L" ard Single-d ret exhaust(bathrooms,
---
Q� toilet Ycompartments,utility rooms) 2.5.32
Phone:($ 3l 936 32i1 I Fax:( ) At icvrawlspace fans _ 25.32
1 c
°s�, ig' i ' , x tea f t x a Other _— 23.32 ( _� i'
yrt.,..a.�sla...,. :.s..,t.. �.r ���� �...._.�"_-"ls��..�•s, 'P"�.,;�„..�. .g. i
Business name:+�� '` A5 ALAI — Fuel Erasing:
_________ $14.15 for first four;$4.03 for_each additional t
Contact name: Furnace,etc. _r
Address: Gas heat pump I I'
— — --- WalLsasoended'unit heater —_ i
City/State/ZIP: Water seater
L 1
Firenlacc
Phone:( ) Fax::( ) i
Range / G';
E-mail: Barbecue I
1001 .11 "t��,.ai` OikittititiiitiNittailigClothes dt'er(as)
Business name: moon, ,4. l� gr Other:
17"' �1'r- !!5 -- 'hipt : 1a t Oct, l( ei 3 C3c. 144,y j2'Q , jr;i t ,,
Address:W i7
Subtotal l'
City/State/ZIP: dtr/�,�./ ,/ Nlinimum permit fee($90.00)
' �h�V^' G`�., OR' (Q�0 Plan review(25%of permit tee)
Phone:( • ) Fax:( ) —
_ — _ Statesurcharge(12%of permit fees
CCB lie.: '•110h+03 TOTAL PERMIT FEE
This permit application expires if a permit is nog obtained within IRO
days after it has been accepted as complete.
Authorized signature._4a__,04ek * Fce in,ahodology act by Tri-County Building'nduatry Scrvicc Board j,
Nair- /O•LZ•Z/ I
[ Print name' Date: 1
h'Bnilding'-Pend MEC_PerntitApp_040I I 3.doc 440.461 rf(I I'02'COM'WEB) r
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Electrical Permit Application RECEIVE t 11t 1 rn( r 1 � w hill i �! I'119
Cit o Ti and Received /y�"�f�C�
.rq f g , Date/BY: — — Permit k: (IU��T"a.C�vL./_—
°I��7 13125 SW Hall Blvd.,Tigard,OR 97223 OCT 21 2021plan Review ���
C Phone: 503.718.2439 Fax: 503.598.1960 _ 1 Date/By: Related Perna 4:
Inspection Line: 503.639.4175 CITY OF TIGARD I Ready Date/13y: Juns: a :ice Page::for
'[':11t;v' Internet: w.ti and-or.gos 1 r` hotificd/Mcthtxi: uppluraeeta1 infarm■tion
g � BUILDING DI Ji.�l0�1 _-- -----_-----------__—.
r 4lc vyi�}.$ a k r"fir' v,,s asp a.'i .t . =r - '-t�' :I: 17.177171
t
1,.; E ' `ex.. it; f1 r 14,;f .,:.... .� 5 . r ,,w, is ie .''T,i *twait;j,i,::i f I �Tt •ii i u 3 I
.�4 i �.$e 3 � � ..._ ......�_... .. s..se.;� P..l��.y,.�:tu:.«.+.i....+"�...:-ru
1.1 New construction 0 Addition/alteration/replacement Plca c cht ck all that apply(submit 2 sets.i'pi ins wt;tenati 1:h;eke.1:
❑Srr,aeor feeder 400 amps ormo•e 0 laid dirt;mr%r:tree stories.
❑Demolition 0 Other: vvtetc the available fault currant 0 t tar.Nis ane 1r-:ntya:,Li.
h. to ty a t$•4 tact ' ,i, R (;! tea ,5_: .i „,., �.}., 'Oil.l eo:e:cs 10.000 n rips at 150 ro n:or ❑1 Icatint buildings.tz
1 and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑eonrmeran-u;e agricultural
atrp:for all otter installations. I uildtngs.
0 Multi-Fimily 0 Master builder 0 Other: 0 Fire pi.mp. ❑I nullatim of 150 K'A or
i _ 1#011l f 5' ❑Enterg%nc•system larger srliately derived
II 1._ Y
❑Addiuonofnew motor toad of ',own,.
Job#: Job site address: I a87? r$o A-NAIANO N/U- Iil4FiP or more ❑°A "l _ •"i•`
❑Star numrosafaotialunits. tccaparrcy.
City/State/ZIP:'.IP: ❑F.eciAontml raicle pa;ks
at 9? ❑ilea!,h•c:refacilities.
Suite/bldg./apt.t.#: Proj ect name: ❑xazarcoua locations. 0 Iupply vol.rsc tie arose:;tan❑Se v :,c or feeder 600 amps or more r00 vein',norn'nal.
__
Cross street/directions to job site: G rt� t Q Alla ;'1:1 FCC €i ti lit I IAEII ' a .,. 7r.:r er '
trxcrf uon [�e r i,I_
Nor residential single-or muhFfamil! dwelling unit.
Subdivision: I Led#; 2, 1nelader attached garage. _-- --_ _.
----- ft.or leek l68.5-0 4
1 -- -1,on(t sal. 7
fax map/parcel# Z 5 1(0 A 0 (1-300 rdd 1500 s .ft.or portion 33.92 .
i
li`s r s ....s..::..._,f k..: r _ "s i i t t 2' Limited rncr!?y,r:sidcntialto — 75.00 2
_ Ea
I.it o
A D,` - 2 / ) (with:above se.ft.)
V l/ vieca Limited energy,multi-family 75.0) ?
residential(with above so.ft.)
� ,Y it Rene)"ale Energy _0 Sae Page 2_ -
.« o f ;r ,., '411� '5," , '- ; &,w i `!ar^'�,..i'1."il:,',.,.,�.-:w -
l:r �. p:.:.� �..; mod. �w�j , -„ Services or feeders installation,atlerat iou utd/or relo�inu
Name. BC-Oe- PA — f2/ZDPi.`L'77t`S 20:1 amp: or less --- - 100-r1 2
2Ul amp:to 400 naps 133.56 2
Address: 33 3 S. .S��i sr Sc/lT� Uic - - -_—_----.--
401 arum to 600 amps 200.34 ,
City/State/ZIP: o.R"t/ t . 9 3¢ -._-_- 601 amp:to 1,00:)amps - - 3C1_03 ,_ 2
Phone:(03) p j,6 TL/. Fax:( ) -- Over 1,000 amps or volts 512.26 _-- 2
Temporary services or feeders installation,alteration,and/nr
Email: P-Ogitted B /u e COW relocation
Owner installation:This installation is being made on property that I own which is not 200 amp:or less 9.36 —._-_ 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amp: to 400 stops 125.0:3 2
Owner signature: Date: 401 amp:to 599 amps _ 163.54 n. i
fi x, xI t ire , ,t ma n t libr. Branch circuits_-new,alteration,of a(tension. erpanel —
. + ,, A.Fee;o-branch circuits with Business name:name: 314-y.fre• abort sstviec)1-feeder fcc, 74.1 .,
r each branch circuit _
Contact name: R :.Ft a-branch circuits Witboul —
—'--- scnvie:or(ceder fee.first Address: brand circuit 50.13 2
City/State/ZIP: �! Each add'I branch circuit --: 7.42 2 11
Miscellaneous(service or feeder not included)__- .
Phone:( ) Fax: •( ) Each manufactured or modular
-—-- dwelling,service and/or feeder 67.&t -`-
Email: Recunner s only _ b7.Et_ 2
l ° r 4 .ors; lk... ' the 4; t't; t +.:r,, :.{u..s 1,.l r .t'zi..1,,i' Pump err rrigation circle - 67.84 — 2
Business name:CA/8y - L��, &-i.ez i.t e,e 'L. i c.c., Sign or oasline lighting b7.iwt '-- 2
S D 77 jQ.1 J� f,i J --i panel, It cuit(s1 or limited-energyns C7 S Page 2- _ 2
Address: panel,alt:ration,or extension. _ _ _
Each additional inspection over al:owuble in any_pf the above
City/State/ZIP:
v- givolviA Q4 47 7 ' Additional inspection(1 hr min) — 56 25/lir -___
Phone:( ) Fax:( ) investigaacn(1 hr min) ; d0.00/hr
Etnail: lndustr a:plant(i hr min) —
—i 18.18/hr
Inspc_tio is for which no fee is 90.00'hr
s t ca is al l listed r:ha min)
CCB Lic,: 2Zto(1'S Electrical Lic,: G/¢6/ Suprv.Lic. E , if:- ---- - ;mit t( fi.1 A tie 1. i l 1
Suprv.Electrician signature,required: _ St.bhttal: - _
Print name: Date: ❑Plan Review Required(25%of pens it lee): __-
` /1 _--Start surcharge(12%ofpem it tee): --._-___
•
Authorized signature: sip /,, �`, //cam- ---_ - TOTAL PERMtf FEE:
yrC Tibia permit application expires If a penult h:sot obtained within ISO
CPrint name: / -/i,.,. Jw i �' Date: / -.2. n,steeple I as complete.
� * 1\umb,r of inspections allowed par peutut.
I Building Permit.'Et.0 PctnutApp_ELR_ERE.dnc Rcv0h/17/211i5 441W6I57(I1,05'COM•1/WEB
8LA KE 5re1/6-V
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Electrical Permit Application—City of Tigard 3 ��(.
Page 2—Supplemental Information D4� PPP"', 1 2
cc� 1" ,
Limited Energy Permit Fees: J ' ,° Renewable Energy Permit Fees:
o8ici a � '� a �,1{tat � :B a�' n....... x, f4 , ��'�ir��' �.t a'��, � • .:�;..,,.
3 Il `r �t l la #afat. �eslti i..;'1 �_
ejlatp,tton (h` Etch I 't ntal "I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: �-- 2
5.01 to 15 kva 133.56
❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 22
Wind generation systems in excess of 35 kva:
E Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to '00 kva 552.26 — 2
n G• arage Door Opener` >100 kw(fee in accordance
552.26 2
with OAR 918-309-0040i ! 1 _ --_—•
❑ H• eating,Ventilation and Air Conditioning j L Solar•generation systems in excess of:5 kva:
System* —Each additional kva over 25 I-7 7.42
C Vacuum Systems* >100 kva—no additional charge 0.0I. ) 1
Each additional inspection over allowable in any of the a bave:
Each additional inspection is
❑ p fi;i 25;hr
Other: � char.ed a an hourly(]hr min)
1nspectioss for which no fee is 9(l 00 hr
l specificallya listed(/,hr min) _-�
a es tt -ram p�;}t= itt
Subtotal kf.nter o t Page I):
Fee for each commercial system: $75.00 N'umbrr of inspections alloyed per permit.--'
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ A• udio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ F• ire Alarm Installation
❑ I3VAC
❑ Instrumentation
❑ Intercom and Paging Systems
Li Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required: Licenses are required for all
other installations
Li Building\Pcm,h.'.ELC_PmmaApp_ELR_ERE.do, Pm 06/I'7/2015
Plumbine Permit Application Q
Building Fixtures RECEIVE r 141H tiV l( h. 1 SF- •iNE it !I f l I ]
ii I'. City of Tigard OCT 2 1 2021 R:ei : Permit No.:
" 13125 SW Hall Blvd.,Tigard,OR 97223 Da[/BY': Q
, Plan Review
Phone: 503.718.2439 Fax: 503.598.196 Other F'rrmi No,
I CITY OF TIGARD DateBy: _--
1 i 1 .) Inspection Line: 503.639.4175 BUILDING DIVISION Date Redjea By: mils: &J See Page 2 for
1 Internet: www.tigard or gov NohfiedlMethod Supp(emental Information
S 8 H"' Yr � i M'4 4 dHG" Sd A21' S7. i r t't 'k9 2. f i SK G'. € �'
i x ( r 3';a k 9rr ei- a tf air. 3a31i i, etxsrlr s ks a 1 i I r izr s 1 is 4 1
_ _ I t w 1,e,, j : Anal,.; ,:,lus:N , Ift c' j. ,r, f'.Irs.;, „1:i, ,4ti,; 1,ls 'r . ?:rt :`,.,t . Y':!z : : s l -
New construction 0 Demolition For special information use checklist.
Description I Qtv. I En I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(inch des IX ft.tar each utility connection)
"'xs of l i R' ^lta a s r :t ; SFR(I)bath -- - 31 :7(1—
;1'° E s3&..ar ; 04, giJi t a E , s; ,t r
l'1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 1 j 437.787
SFR(3)bath I 500.32
❑Accesso:y building 0 Multi-family — '
- Each additional bath/kitchen I 25.02
❑Master builder 0 Other Fire sprinkler( ,sq.ft.) ��'U Page
i 7 tiI f,t�,� x Y.t wttq� - 7 ,�c� ] 'c t t s r :
k..d 1 jiti1i it 's ' 9#� 1, :..E:. N.>�_.s ,.�.. �.. ..,... . , ION�r`•:» Site utilities: -.--.._._—_-
Job site address: /0 8 7 3 5'(z/ 4owe y/!GDr Catch basin or area drain 18.76
y / C 6 DA-- y7D _— -_ _ o draleain
line; a trench drain H ,al:72,
Cit iState./Z1P: b Fooling drain(no.linear ft.:�) i.at;:':'.
Suite/bldg./apt.no.: Project name: Manufactured borne utilities - 50(i
Cross street/directions to job site: c,//_71c y i /wo °oar Manholes 1 1E:76��—
' Rain drain connector 18:7u
Sanitary sewer(no.linear fl.:_) I Pat;_ -!-
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page
-Subdivision: Lot no.: 2, Fixture or item: ____— ___•_-_-_
Tax map/parcel no Backflow prev enter — 31.2" --
s 11 d� l Z /r -{----
s im ice, i ra '-. m,� t r r I ,1 W t i lei i eL. Backwater valve —_-1 17.51 -
/�//��,) Clothes washer ( � 2`A:'
/7✓I� Z UPIerl �Vii�., Dishwasher I 25.02
_ Drinking fountain 25.02
Ejectors/,,ttnrp ' 25 0_.
o tit{ i € itj i 141 c<gi��a• 1 s a,, , lee s' Expansion tank ---- 12.51
Y :..'_"t g�I 1 �, r.-...+..M� ,:..tA :ricer th :T'.~x� ....;I at
G tM ,.b'xsla s:r..:b,,... ., .r.... .:r,..,. i�.t.e ,,, Al ...;AO s -
�1.ur�� ^ ioge neS Fixture/seweroordadrain/floor
I 25.0:1
Name: i'v[J — -- —-------
_ Floor draittitloot•sinkfiub I 25.0:'.
Address: 3 3 Jt 5• ✓r F Sr /(J/m- ✓42- -125.0
/f G �,/ Garbage(hsposal x —-- --
City/State,'ZIP: l✓A x� aidEr2 , oi" . 7 7034 _ Huse bib ---_----I- 07
Phone:(03) Q36 girl. Fax ( ) Ice maker -- L 12 5 I - ,
tt s`tiii;';.161 r' ( ipE t ' s.. 's4 T.hiE'£`J:'E43N' Interceptorlgruasetrap 25 _—___—.._
Business name: E Medical gas(v '.::
((value:S_) --- Page
-
Primer 12.51
Contact name: .
Root drain(commercial) I.5 i
Address: Sink/basin'lavatory .' 25.02
City/State/ZIP: Solar units(potable water) 62.5z—
Fax: ( ) Tub/showerisllower pan —?j-__VLSI
Phone:( ) - ---- -
Urinal _ 25.0::
E-mail: — _--- --_-_
r #:P r It:ee t 4rIF t o r ' 5 r wing Water closet — / 25 0---
.` ^'s r-b ,... , ss,.,s ems", ,'}i'ng. ;r z .w,,u-,A ine t; Water heater 37 5::
Business name: /( -9 PI_IJ/lBYN& Water piping/DWV -_----:--5E,21),---__
Address: /3? Se 13,. Other: ---- -- ?`.0:-----
Po�T LQ -
________
Phone:(53) q7 - 5-000 Fax:( ) Minimum perrnil fee: S72 51) ---!
Plan review (25%ofpennit.'ee)
CCB Lie.: ./ l76 `7 Plumbing Lie.no.: is 370 - - -- ---_._-
State surcharge(l 2%ofpen-(nt re0 i
Authorized signature: afe„.. O-rA1.P2R'41"1'F'cE
Print name: �,�y(J paw; -- I This permit application expires If a permit is net nbluined within ISO days
J after It bas been accepted as complete,
*Fcc methodology set by Tri-County Bulling Indut:r:5cr'ice Board.
L'.sulklin(G+Pcrmils'PCMU-PurnulApp.dnc 10/(11(19 440-44,I(Tt 10/112 Cf:M'W'EB)
+atrr
juvo
ii: '' '. ..
Plumbing Permit Application - City of Tigard 0 Soi /'
Page 2 - Supplemental Information ¶ t1L'
1
Fee Schedule: Residential Fire Su I ressian S stela
v + il Y ri - ��. '�, •
s ... 3'a'S RI lI !c'.: 1 � w'�� r j �t!'! ;
n +s 3 :t 1. `e' 11 1 3 i..f a ,:,,i1 lsr r, ul,• la`11,1 t i.. ')il.
..-°: ; : t,. a art . :a r dn. . . . �v .
Footing,rain-1"100' 50.03 0 to 2000 .121.90
37.52 2 001 to 3 600 169.69 �-
Footing dr each additional 100' 3 601 to 7,200 $23 0
Sewer- 1st 10)' 62.54 ----��+-
7,201 and greater $327.54
Sewer-each addit'nal 100' 37.52.
Water Service-1st 1 ri' 62.54 Medical Gas Systems:
Water Service-each addi' nal 1.00' 37.52 ! �! r `r °i �`p) sli g'll l e ii r 3 4p a!
- It '. �`lit4l9r �YtId1L.J'ti El
Storm&Rain Drain- 1st 100 62.54 $1.00 to$5,000.00 Minimum fee$72 50
Storm&Rain Drain-each additio .1100' 37.52 $5.001.00 to$10,000.0C $72.50 rot the first$5 000.00 and$1.52 for
£ $ each additional$100.(0 o fraction Thereof,to
tifttri
Inspection of existing plumbing or for $10.001.00 to:625,000.00 $148.50 for the first$10,0 5.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.(r(t or fraction thereof,to
,minimum charge-1/2 hour) and includin $25,000.00._ _
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$15,030.00 and$1.45 for
hours(minimum charge-2 hours) each additional S 100.00 of fraction thereof,to
Reinspcction Fccs 0.00/hr - and including$50,000.00.__
Additional plan review for revisions 90. air $50,001 00 and up $742.00 for the firs-$50,030.00 and$1.20 for-
each additional S100.00 a fraction thereof._
(minimum charge-1/2 hour)
Subtotal:
,
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees". &` ; trt I'= ,,.DNA,i. .. 'art ,„ ,, „,t,
7 : r 1 z: Plan review is required for anythe following.
Ire < 1 rre :
iti�}<x �tv�se, y �� � 1 ,
_ ,-f r 14 t - � ' i "£ 1: : ft �; 4` Please check all that apply.
iWt $; .•?, .. i; ' - ,iRt !ts,; ❑ Any new commercial building with water service 2"and
Baptistry/Font _ greater,except systems designed and minced by licensed
Bath: - 6/Shower engineer.
Jacttzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
t
Car Wash: -Eachali as defined in OAR918-780-0040.
-Drive lhnl
Cuspidor/water Aspirator ' ❑ Medical gas and vacuum systems for health care facilities.
po
Dishwasher: -Commercia ❑ Any multipurpose fire sprinkler system.
Domesuc\ [i Any complex structure as defined in GAR918-780-0040.
Drinking Fountain \
Eve Wash Submit 2 sets of plans with any of tLe above.
Floor Dr'ain'sink: -2" yy - rz cl; »r u i
3" \ 1'l.xia 1 s.I ,: 1 I � ,,taE r
4" \ I ' Isometric or riser diagram is required for new buildings
-Car Wash Drain \ that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related '•
Ice MachiRefrig.Drains \ Comments regarding fixture work:
Oil Separator Gras Station) \\ --
Rec.Vehicle Dump Station - --
Shower: -Gang
-Stan \\ - __ --
Sink: -lav/Bar non-food related
-
-Bradley \
-Com/Serv/Util food related
-Service *Note: If the feature work under this permit results in an
Swimming Pool Filter increase of sewer IEDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toi let
Urinal •
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
■ .
TicARD Building Permit Review — Residential
Building Permit #: —Site Address: 1 Q '3 6"W 4vj✓, Hilt
It �--
Project Name: 4-VI,(11.,J 1--Ft n, 04-. Par-l....ri- Vi Lot #: 'Z-
Planning Review 4/61.,j"ds_ forn,l y G 1, t-t. er ►r..tie-i.
Proposal: S a
gi Verify address/suite#active in Accela. ❑ In River Terrace: , No ❑ Yes,River Terrace Review Addendum
Site Plan Elements: gErosion Control
93 copies of site plan on 8-1/2"x 11"or 11 x 17"paper f Retained trees with drip line and tree protection measures
IeiDrawn to scale(standard architect or engineer scale) 1 ootprint of new structure(including decks)and FFL
FPNorth arrow ZgUtility locations&easements(required for new and additions)
Site address,project or subdivision name and lot number Sidewalk/driveway approach
gApplicant information(name and phone number) ❑Location of we s
' Lot dimensions and building setback dimensions -Street tree size,type and location
0„^r' footage of buildings to-Ix.dcinolishetl--. 1Street names
Qgx tstlitg- t =site.- re n 4'differential)
iiLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? [ 'es ❑No
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes Ptl\Io
Fp Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ,Ef No Received: ❑ Yes ❑ No
kit Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: r Yes,applicant was notified ❑ No Received: Yes ❑ No
I SDC Exemption for ADU applied for: ❑ Yes jg4 No Received: ❑ Yes ❑ No
gii Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified e No Applied For: ❑ Yes ElNo,stop intake
Land Use Case#: 24-61(J 2 2-it9 — OC,C5 2-2- P Zoning:O_ f 7i
C' Required Setbacks: Front: 1 5 c Rear: 15 t Side: C ` Street Side: t d ` Garage: 2.0 1
Building Height: Max.Height: 5 t Actual Height: 2,5 . i
Landscape Area: % Lot Coverage Max: ��
Entrance Ip Set back no more than 8'from street-facing wallIP Parallel to street or offset 45 degrees or less
Windows [Minimum 12%of area of all street-facing facades
Garage e door is behind widest street-facing wall ❑ Yes ❑ No,one o Izeiowing is met:
❑ Door ds no more than 5'from wall and there is a covered porc ing beyond garage.
❑ Door extends no n 5'from wall and there is a 1 .window above garage on 2°d floor.
❑ Garage door width is ❑ 12'or less 0. o facade ❑ 60%or less and includes 7 of following:
❑ Covered porch ❑ Reces rance ❑ a ❑ 1'Roof eave ❑ Roof offset
❑ Fire shin les Lap Siding ❑ Roof pitch ❑ Gable, p, el roof ❑ Dormer
❑ cent siding ❑ Window trim ❑ Window recess ❑ Window projection alcony
IA Visual Clearance Jai Urban Forestry Plan
Fi Sensitive Lands: ❑ Yes No Type:
Conditions met prior to issuance of building permit
Notes:
42 Approved By Planning: )4 r Date: (Cf7�S/Zd '2—(
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPennitRvw_RES_122419.docx
Building Permit Submittal
Original Submittal Date: 0140
Site Plans: # ,
Building Plans: # 3
Building Permit#: [Enter building permit# above.
Workflow Routing: [Planning G 'Engineering [Permit Coordinator Building
Workflow Sign-off: lk-Sign-off for Planning(include notes from planning review)
Route Application Documents: [Y]/-Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Er Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: ' tl& J GCS `ll1,/1 , 4 i. r .,al2t '-� b (Ai iXt f !yt//C ,49F Cr4cfr1
By Permit Technician: 01/ - / Date: /D/2?/.202 f
Engineering Review
Slope at building pad: ZG,'
ttr Conditions "Met"prior to issuance of building permit
(('Easements (encroachments) per engineering conditions of approval and plat
Dr Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes WNo
Assess Water Quantity Fee in-lieu: ❑ Yes
LIDA Facility on lot: "Yes
Final Plat Recorded:
I 'NOT Approved by Engineering: Date: ///s/Z/
Notes: AS et clsIP
VApproved by Engineering: Date: !�/��I�
l
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
iLf Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: 'jf J Intik Date: 1 i/6 42,67 t
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption: Received IVO Does not apply ..-A-prwriA
SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: j Yes ❑ N/A
Parks SDC: �J Yes El N/A \
�\
LIDA ❑ Yes g N/A- ✓�
OK to Issue Permit
Approved by Permit Coordinator: 4 Date: it (202(
1:\Building\Fonns\BldgPermitRvw_RES_122419.docx
I
RECEIVED
JAN 1 0 2022
City ofTigard CITY OF TIGARG
_ FINANCE DEPARTMENT
Systems Development Charge (SDC) Exemption GA�pplication
TIGARD
REQUEST FOR ACCESSORY DWELLING UNIT (ADU) SDC EXEMPTION
(Allowed under TMC 3.24.100.F)
Note:Refer to TMC 3.24.180 and the Systems Development Charge(SDC)Exemptions for AccessotyDwelling Units
Guideline for eligibility requirements before completing application.City Transportation and Park SDCs exemption
only.
PROPERTY INFORMATION REQUIRED DOCUMENTS
❑ Recorded Deed with the legal
Name of property owner(s): Blue Palouse Properties description of the Property
❑ Proof of Ownership/
Authorized Representative
Address of ADU : 10873 SW Annand Hill Ct
Tax map and tax lot numbers:
2s 110 ad 12300
Land Use Approval Case Number: MAP 2020-00002 ADU 2020-0021,0022,0023
Type of Unit Total Units Square footage of each unit
Attached ADU 1 992
Detached ADU
APPLICANT INFORMATION
Name(s),as appears on title of property: Blue Palouse Properties
, Mailing address: 333 s state st Suite V452 City/State: or Zip:
1 97034
Phone: 503-936-3212 Email: robm@bluepalouse.com
Applicant's representative (if not property owner):
Phone: Email: robm@bluepalouse.com
THE PROPERTY OWNER ACKNOWLEDGES AND AGREES TO THE
FOLLOWING:
1. I understand that acceptance of this application and required documents by the City does not constitute an
f approval of an exemption. Exemptions are not granted until after all required documentation is received, the
property owner(s) sign, notarize and record with Washington County the restrictive covenants agreement.
2. I understand that if at any time during a period of 10 years from the time my final inspection is approved the
Page I 1 Rev.10/21
accessory dwelling unit for which an exemption is granted is rented or listed as a short-term rental(AirBnb,
VRBO,etc.),the owner of the property at that time will be required to pay to the City the amount of the
exempted system development charges,plus interest. I also understand that an advertisement of the accessory
dwelling unit as a short-term rental is sufficient evidence for the city to assess the amount of the exempted SDCs.
I understand that this restriction will bind the property even through transfers of ownership.
3. I understand that the City may verify any of the information contained in this application at any time.
4. 1 understand that the City,its agents,successors and assigns will rely on the information contained in this
application and the information represented herein;if any information should change prior to obtaining a
certificate of occupancy,I will notify the City.
I certify that to the best of my knowledge,all the information provided in this application is true and accurate as of
the date rovided opposite my signatures below.
Rob Matthews 11/23/21
r •rty owner signature Print Name Date
Property owner signature Print Name Date
APPLICANTS
it is the responsibility of the applicant to ensure that the application for the SDC exemption is submitted and approved
before the payment of all SDCs are due to the City. SDCs are calculated and due and payable pursuant to Tigard
Municipal Code 3.24.080. In accordance with TMC 3.24.080.B,the City may not issue a building permit or allow
connection to the City's systems until either all SDCs have been paid in full or an exemption has been granted. It is the
applicant's sole responsibility to ensure an exemption application is submitted to the City in a timely manner in order to
meet the timelines in TMC 3.24.080.
Electronic submittal of this application and required documentation is preferred and can he sent to SDC(.tigard-
ot.gov
1-Iardcopy applications and required documentation can be mailed to:
City of Tigard—SDC Administrator, 13125 SW Hall Blvd.,Tigard,OR 97223.
Questions can be directed to Christine Moody,at christine(ati>ard-or.gov or 503-718-2415.
STAFF I ISE ONLY
Date Received: 11/23/21 Approved b)Christine Baker 1/6/22 Dai`: 11/23/21
Amount of SDCs Exempt $11 719.00 Park $7,591.00 Transportaticut $4,128.00
Page 12 Rev.10/21